Sleep tendency as a measure of recovery after drugs used for ambulatory surgery

Abstract

Background: Although tests of psychomotor function indicate that drug effects after ambulatory anesthesia are short-lived, patients often feel washed out for long periods of time. Among the psychomotor tests that measure different motor and cognitive functions, none directly measures sleepiness or alertness. The authors hypothesized that sleepiness, measured by a sleep latency test, would be a more sensitive indicator of drug effect after an anesthetic than psychomotor tests. The second objective was to determine a sedation regimen that produced the least residual effect. Methods: On four separate occasions, volunteers (N = 12) received an injection of propofol 2.5 mg/kg; propofol 2.0 mg/kg and fentanyl 2 μg/kg; propofol 2.0 mg/kg and midazolam 2 mg/70 kg; or midazolam 0.07 mg/kg and fentanyl 2 μg/kg. Dependent measures included the multiple sleep latency test (MSLT), Maddox Wing and digit symbol substitution tests, auditory and visual reaction times, and a divided attention task. Results: The multiple sleep latency test demonstrated sleepiness up to 4 h after injection, and in some patients, sleepiness continued up to 8 h afterward. Psychomotor function was impaired only at 2 h after injection of the drug combination. Conclusion: The multiple sleep latency test may be a more sensitive measure of a drug's effect than other tests of psychomotor function. For up to 8 h after an injection of midazolam and fentanyl, patients must consider driving or operating heavy machinery unsafe activities.